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modern nephrology

Carmine Zoccali, Raymond Vanholder, Ziad A Massy, Alberto Ortiz, Pantelis Sarafidis, Friedo W Dekker, Danilo Fliser, Denis Fouque, Gunnar H Heine, Kitty J Jager, Mehmet Kanbay, Francesca Mallamaci, Gianfranco Parati, Patrick Rossignol, Andrzej Wiecek, Gerard London
The accurate definition and staging of chronic kidney disease (CKD) is one of the major achievements of modern nephrology. Intensive research is now being undertaken to unravel the risk factors and pathophysiologic underpinnings of this disease. In particular, the relationships between the kidney and other organs have been comprehensively investigated in experimental and clinical studies in the last two decades. Owing to technological and analytical limitations, these links have been studied with a reductionist approach focusing on two organs at a time, such as the heart and the kidney or the bone and the kidney...
April 24, 2017: Nature Reviews. Nephrology
Kamyar Kalantar-Zadeh
BACKGROUND: Exogenous replacement of erythropoietin (EPO) by recombinant human EPO has been considered a standard of care for the treatment of anemia in patients with chronic kidney disease for more than 20 years. Genetically engineered biologic proteins derived from human, animal, or microorganism sources are a major area of growth in modern medical care, accounting for one-third of new drug approvals in the past decade. Despite benefit to patients, the use of biologics comes at a significant cost, representing one of the fastest growing segments of strained healthcare budgets around the world...
2017: American Journal of Nephrology
Rolf Bambauer, Reinhard Latza, Daniel Burgard, Ralf Schiel
Since the mid 1970s, when membrane modules became available, plasma separation techniques have gained in importance especially in the past few years. The advantages of this method are a complete separation of the corpuscular components from the plasma and due to increased blood flow rate and higher efficacy. Systemic autoimmune diseases based on an immune pathogenesis produce autoantibodies and circulating immune complexes, which cause inflammation in the tissues of various organs. In most cases, these diseases have a poor prognosis without treatment...
February 2017: Therapeutic Apheresis and Dialysis
Anna Greka, Deb Gibson, Peter Mundel, George Demetri, Friedhelm Hildebrandt, Martin Pollak, Jose Florez
In the face of ever-increasing incidence and prevalence of kidney disease worldwide, the unmet need for new treatments is unprecedented. Precision medicine is defined as the use of modern technologies to identify mechanisms of diseases in individual patients, and thus deploy treatment using tailored, targeted approaches, in the hopes of avoiding unnecessary toxicities and complications. Is there a place for kidney disease therapeutics in this space? If so, what is required to make significant progress toward precision nephrology? To answer these critical questions, we present a series of personalized comments corresponding to the responses offered to these very questions during the Inaugural Glom-NExT Symposium held at Harvard Medical School on October 23, 2014, a national meeting focused exclusively on kidney disease therapeutics...
November 2016: Seminars in Nephrology
John K Roberts, Matthew A Sparks, Ruediger W Lehrich
Interest in nephrology among trainees is waning in the USA. Early perceptions and attitudes to subject matter can be linked to the quality of pre-clinical curricula. We wanted to explore these attitudes in the setting of modern curriculum redesign. We utilized Q methodology to understand first-year medical student attitudes after an innovative kidney physiology curriculum redesign that focuses on blending multiple learning methods. First-year medical students were invited to take a Q sort survey at the conclusion of a kidney physiology course...
November 2016: Renal Failure
Rolf Bambauer, Reinhard Latza, Daniel Burgard, Ralf Schiel
The process of curing a patient by removing his illness by extracting blood is a very old one. Many years ago, phlebotomy was practiced to cure illness. Now, this old process, placed on a rational basis with therapeutic apheresis (TA), is being followed in clinical practice. Therapeutic plasma exchange (TPE) with hollow fiber modules has been used in different severe diseases for more than 40 years. Based on many years of experience with the extracorporeal circulation in end-stage renal disease, the authors herein give an overview of TA in immunological diseases, especially in hematologic, autoimmune and dermatologic diseases...
October 2016: Therapeutic Apheresis and Dialysis
Marco Cascella
Professor Giuseppe Moscati (1880-1927) was canonized by the Catholic Church in 1987. This act recognized the extraordinary qualities of a doctor who, considering his work as a "sublime mission", dedicated his life to helping the sick. The fame of the "Holy doctor" or "doctor of the poor", as people called him, was soon widespread and, immediately after his death, made him the subject of several biographies. These treatises, mainly written by religious hagiographers, have little analyzed Moscati as a doctor and scientist, or, in rare cases, privileged the description of his medical career, touching only marginally salient aspects of his work as a scientist and researcher...
August 2016: Acta Medico-historica Adriatica: AMHA
Jolanta Malyszko, Jacek S Malyszko
INTRODUCTION: Anemia has been remained one of the most characteristic and visible manifestations of chronic renal failure. Correction of anemia requires two main treatment strategies: increased stimulation of erythropoiesis, and maintenance of an adequate iron supply to the bone marrow. AREAS COVERED: Erythropoiesis activating agents became a mainstay in the treatment of renal anemia for more than 25 years. Recently, there have been several attempts to introduce new drugs to stimulate erythropoiesis or affect the hepcidin-ferroportin pathway...
September 2016: Expert Opinion on Emerging Drugs
Ayano Miyagi, Aiwu Lu, Benjamin D Humphreys
Biologic research is experiencing a transformation brought about by the ability of programmable nucleases to manipulate the genome. In the recently developed CRISPR/Cas system, short RNA sequences guide the endonuclease Cas9 to any location in the genome, causing a DNA double-strand break (DSB). Repair of DSBs allows the introduction of targeted genetic manipulations with high precision. Cas9-mediated gene editing is simple, scalable, and rapid, and it can be applied to virtually any organism. Here, we summarize the development of modern gene editing techniques and the biology of DSB repair on which these techniques are based...
October 2016: Journal of the American Society of Nephrology: JASN
Jadranka Buturovic-Ponikvar
Citrate has many characteristics of the ideal anticoagulant for hemodialysis. In addition to immediate and complete anticoagulation in the dialysis circuit, citrate has important effects beyond anticoagulation, mainly in reducing inflammatory response induced by hemodialysis. Citrate has already become the standard anticoagulant in acute kidney injury requiring continuous renal replacement therapy (CRRT), both for adults and children, with the citrate module being a part of modern CRRT monitors. Although the citrate module is not yet available for intermittent hemodialysis, precise infusion pumps, point-of-care ionometers and high citrate clearance from high flux dialyzers increase safety while reducing the risk of metabolic complications, both in adult and pediatric patients...
June 2016: Therapeutic Apheresis and Dialysis
Laura J Maursetter, Lauren D Stern, Stephen M Sozio, Ankit B Patel, Reena Rao, Hitesh H Shah, Katlyn Leight, Mark D Okusa, Mark L Zeidel, Mark G Parker
The Kidney Tutored Research and Education for Kidney Students (TREKS) Program is a product of the American Society of Nephrology (ASN) Workforce Committee that seeks to connect medical and graduate students to nephrology. This program starts with a weeklong camp-like course introducing participants to renal physiology through classic and modern experiments. Next, each student is matched with a nephrology mentor at his or her home institution to foster a better understanding of a nephrology career. Lastly, the students are encouraged to participate in scholarly activities and attend the ASN Kidney Week...
June 2016: Journal of the American Society of Nephrology: JASN
Yueh-An Lu, Shen-Yang Lee, Hui-Yi Lin, Yen-Chun Liu, Huang-Kai Kao, Yung-Chang Chen, Ya-Chung Tian, Cheng-Chieh Hung, Chih-Wei Yang, Hsiang-Hao Hsu
BACKGROUND: Reconsidering when to initiate renal replacement therapy (RRT) in patients with chronic kidney disease (CKD) has been emphasized recently. With evolving modern aged and diabetes-prone populations, conventional markers of uremia are not sufficient for determining the optimal timing for dialysis initiation. This retrospective cohort study examined the association between hyperphosphatemia and uremic patients who need RRT registration. METHODS: All patients from the department of nephrology in one tertiary medical center in northern Taiwan who had advanced CKD and estimated glomerular filtration rates <8 mL/min/1...
December 2015: Biomedical Journal
Natale Gaspare De Santo, Carmela Bisaccia, Biagio Ricciardi, Pietro Anastasio, Giovanni Aliotta, Giuseppe Ongaro
AIM: The study was devised to understand the contribution to nephrology ofDe Medicina Methodicaof Prospero Alpini published in 1511, at a time when the fame of the professor reached the azimuth. METHOD: We have analyzed the contents of chapters devoted to nephrology in that book of Prospero Alpini and the novelties of his message. RESULTS: Prospero Alpini (1563-1616) taught at the University of Padua (1594-1616), at the same time of Galileo Galilei, Santorio Santorio, and Girolamo Fabrizi dAcquapendente, when measurements (pulse, temperature, perspiration) were introduced into medicine...
February 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Magdalena Bartmańska, Andrzej Więcek
Along with instant aging of the world population the prevalence of chronic kidney disease is constantly growing. Over the past decade, the largest increase in the incidence of end-stage CKD was observed especially among subjects aged 80 and over. Realizing that renal replacement therapy is a heavy burden on health care it is critical to prevent end-stage kidney disease. To do so the risk and predisposing factors leading to development of renal failure have to be recognized. Among them are comorbidities such as diabetes, hypertension significantly associated with elderly, but also numerous of socioeconomics aspects...
February 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Cristiana Rollino, Carlo Bagliani, Dario Roccatello
This paper reports a description of the characteristics of the Nephrology and Dialysis department of the Yangzhou Northern Peoples Hospital (Jiangsu province - China) observed by the Author in a two weeks stay. The most outstanding remark is that, in spite of the modern and highly developed structure and information technology of the hospital, the Chinese Health System, an insurance based system, doesnt cover all the care expenses, leaving the remaining cost to be payed by the patients (about 30%). This often induces an empirical method of treatment of nephropathy, because of the lack of a histologic diagnosis and a minimalistic approach for choosing drugs...
January 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Michelle N Rheault, Lei Zhang, David T Selewski, Mahmoud Kallash, Cheryl L Tran, Meredith Seamon, Chryso Katsoufis, Isa Ashoor, Joel Hernandez, Katarina Supe-Markovina, Cynthia D'Alessandri-Silva, Nilka DeJesus-Gonzalez, Tetyana L Vasylyeva, Cassandra Formeck, Christopher Woll, Rasheed Gbadegesin, Pavel Geier, Prasad Devarajan, Shannon L Carpenter, Bryce A Kerlin, William E Smoyer
BACKGROUND AND OBJECTIVES: Children with nephrotic syndrome can develop life-threatening complications, including infection and thrombosis. While AKI is associated with adverse outcomes in hospitalized children, little is known about the epidemiology of AKI in children with nephrotic syndrome. The main objectives of this study were to determine the incidence, epidemiology, and hospital outcomes associated with AKI in a modern cohort of children hospitalized with nephrotic syndrome. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Records of children with nephrotic syndrome admitted to 17 pediatric nephrology centers across North America from 2010 to 2012 were reviewed...
December 7, 2015: Clinical Journal of the American Society of Nephrology: CJASN
Jonathan J Hogan, Michaela Mocanu, Jeffrey S Berns
The kidney biopsy is the gold standard in the diagnosis and management of many diseases. Since its introduction in the 1950s, advancements have been made in biopsy technique to improve diagnostic yield while minimizing complications. Here, we review kidney biopsy indications, techniques, and complications in the modern era. We also discuss patient populations in whom special consideration must be given when considering a kidney biopsy and the important role that the kidney biopsy plays in nephrology training...
February 5, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Csaba P Kovesdy
We are in the midst of an epidemic of overnutrition which has resulted in a widespread increase in obesity rates in modern societies. Yet for patients suffering from serious chronic illnesses such as end stage renal disease (ESRD), malnutrition (encompassing both inadequate quantity and quality of nutrient intake) represents a far more significant danger. Protein-energy wasting has been identified as one of the strongest risk factor for adverse outcomes in ESRD patients, and modeling studies have suggested that improving nutrition could result in substantial lowering of mortality rates and other benefits...
January 2016: Seminars in Dialysis
Noha A Osman, Safaa M Hassanein, Marwa M Leil, Mohamed M NasrAllah
OBJECTIVE: To explore and compare complementary and alternative medicine (CAM) practice among subsets of patients with chronic kidney disease (CKD) and renal allograft recipients. DESIGN: Cross-sectional survey questionnaire. SETTING: Three outpatient nephrology clinics and dialysis centers in Egypt. SUBJECTS: A total of 1005 subjects were included in the study (560 predialyis patients with CKD 3-4, 245 patients on hemodialysis, and 200 transplant recipients)...
November 2015: Journal of Renal Nutrition
Peter Mundel, Anna Greka
PURPOSE OF REVIEW: A core mission for modern medicine is the development of precision therapeutics. Cancer therapies have been at the leading edge of this effort, while nephrology has lagged on the path to precision medicine. Breaking the stalemate, recent work revealed CD80 (B7-1) as a candidate for targeted therapy in the treatment of resistant nephrotic syndrome. This review aims to summarize the current state of our understanding of podocyte CD80 biology, its therapeutic implications and the challenges that lie ahead in essential future validation studies...
July 2015: Current Opinion in Nephrology and Hypertension
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